Comparisons of Medical Student Knowledge Regarding Life-Threatening CT Images Before and After Clinical Experience

Introduction. Currently, no national standard exists for educatingmedical students regarding radiography or formal research indicatingthe level of improvement regarding computed tomography(CT) interpretation of medical students during clinical rotations. Methods. Students were evaluated based on their response totwenty-two open-ended questions regarding diagnosis and treatmentof eleven de-identified CT images of life-threatening injuries.The number of incorrect answers was compared withcorrect or partially correct answers between students startingthird-year clinical rotations and those starting their fourth year. Results. Survey results were collected from 65 of 65 (100%) beginningthird-year students and 9 of 60 (15%) beginning fourthyearstudents. Students in their fourth-year had less incorrectanswers compared to third-year students, with five questionsreflecting a statistically significant reduction in incorrect responses.The image with the least incorrect for both groups wasepidural hemorrhage, 33.9% and 18.5% incorrect for third-yearstudents for diagnosis and treatment, respectively, and 11.1%and 0% incorrect for fourth-year students. Outside of this image,the range of incorrect answers for third-year students was75.4% to 100% and 44.4% to 100% for fourth-year students. Conclusion. Baseline CT knowledge of medical students,regardless of clinical experience, indicated a strong deficit,as more students were incorrect than correct for themajority of CT images. KS J Med 2017;10(3):55-58

Assessing Medical Student’s Ability to Interpret Traumatic Injuries on Computed Tomography Before and After the Third Year Clerkships

Introduction. Exposure to radiologic images during clinical rotationsmay improve students’ skill levels. This study aimed to quantifythe improvement in radiographic interpretation of life-threateningtraumatic injuries gained during third year clinical clerkships (MS-3). Methods. We used a paired-sample prospective study design tocompare students’ accuracy in reading computed tomography (CT)images at the beginning of their third year clerkships (Phase I) andagain after completion of all of their third year clerkships (Phase II).Students were shown life-threatening injuries that included head,chest, abdomen, and pelvic injuries. Overall scores for Phase II werecompared with Phase I, as well as sub-scores for each anatomicalregion: head, chest, abdomen, and pelvis. Results. Only scores from students participating in both Phase Iand Phase II (N = 57) were used in the analysis. After completingtheir MS3 clerkship, students scored significantly better overall andin every anatomical region. Phase I and Phase II overall mean scoreswere 1.2 ± 1.1 vs. 4.6 ± 1.8 (p < 0.001). Students improved the mostwith respect to injuries of the head and chest and the area of leastimprovement was in interpreting CT scans of the abdomen. Althoughimprovements in reading radiographic images were noted after theclerkship year, students accurately diagnosed only 46% of life-threateningimages on CT scan in the trauma setting. Conclusions. These results indicated that enhanced education isneeded for medical students to interpret CT scans.Kans J Med 2018;11(4):91-94

Spectroscopy on a single trapped 137Ba+ ion for nuclear magnetic octupole moment determination

We present precision measurements of the hyperfine intervals in the 5D3/2 manifold of a single trapped Barium ion, 137 Ba+ . Measurements of the hyperfine intervals are made between mF = 0 sublevels over a range of magnetic fields allowing us to interpolate to the zero field values with an accuracy below a few Hz, an improvement on previous measurements by three orders of magnitude. Our results, in conjunction with theoretical calculations, provide a 30-fold reduction in the uncertainty of the magnetic dipole (A) and electric quadrupole (B) hyperfine constants. In addition, we obtain the magnetic octupole constant (C) with an accuracy below 0.1 Hz. This gives a subsequent determination of the nuclear magnetic octupole moment, {\Omega}, with an uncertainty of 1% limited almost completely by the accuracy of theoretical calculations. This constitutes the first observation of the octupole moment in 137 Ba+ and the most accurately determined octupole moment to date.Comment: 4 pages, 3 figure

Over-expression of Grhl2 causes spina bifida in the Axial defects mutant mouse

Cranial neural tube defects (NTDs) occur in mice carrying mutant alleles of many different genes, whereas isolated spinal NTDs (spina bifida) occur in fewer models, despite being common human birth defects. Spina bifida occurs at high frequency in the Axial defects (Axd) mouse mutant but the causative gene is not known. In the current study, the Axd mutation was mapped by linkage analysis. Within the critical genomic region, sequencing did not reveal a coding mutation whereas expression analysis demonstrated significant up-regulation of grainyhead-like 2 (Grhl2) in Axd mutant embryos. Expression of other candidate genes did not differ between genotypes. In order to test the hypothesis that over-expression of Grhl2 causes Axd NTDs, we performed a genetic cross to reduce Grhl2 function in Axd heterozygotes. Grhl2 loss of function mutant mice were generated and displayed both cranial and spinal NTDs. Compound heterozygotes carrying both loss (Grhl2 null) and putative gain of function (Axd) alleles exhibited normalization of spinal neural tube closure compared with Axd/+ littermates, which exhibit delayed closure. Grhl2 is expressed in the surface ectoderm and hindgut endoderm in the spinal region, overlapping with grainyhead-like 3 (Grhl3). Axd mutants display delayed eyelid closure, as reported in Grhl3 null embryos. Moreover, Axd mutant embryos exhibited increased ventral curvature of the spinal region and reduced proliferation in the hindgut, reminiscent of curly tail embryos, which carry a hypomorphic allele of Grhl3. Overall, our data suggest that defects in Axd mutant embryos result from over-expression of Grhl2

A comparison of Eulerian and Lagrangian transport and non-linear reaction algorithms

When laboratory-measured chemical reaction rates are used in simulations at the field-scale, the models typically overpredict the apparent reaction rates. The discrepancy is primarily due to poorer mixing of chemically distinct waters at the larger scale. As a result, realistic field-scale predictions require accurate simulation of the degree of mixing between fluids. The Lagrangian particle-tracking (PT) method is a now-standard way to simulate the transport of conservative or sorbing solutes. The method’s main advantage is the absence of numerical dispersion (and its artificial mixing) when simulating advection. New algorithms allow particles of different species to interact in nonlinear (e.g., bimolecular) reactions. Therefore, the PT methods hold a promise of more accurate field-scale simulation of reactive transport because they eliminate the masking effects of spurious mixing due to advection errors inherent in grid-based methods. A hypothetical field-scale reaction scenario is constructed and run in PT and Eulerian (finite-volume/finite-difference) simulators. Grid-based advection schemes considered here include 1st- to 3rd-order spatially accurate total-variation-diminishing flux-limiting schemes, both of which are widely used in current transport/reaction codes. A homogeneous velocity field in which the Courant number is everywhere unity, so that the chosen Eulerian methods incur no error when simulating advection, shows that both the Eulerian and PT methods can achieve convergence in the L1 (integrated concentration) norm, but neither shows stricter pointwise convergence. In this specific case with a constant dispersion coefficient and bimolecular reaction A+B¿P, the correct total amount of product is 0.221MA0, where MA0 is the original mass of reactant A. When the Courant number drops, the grid-based simulations can show remarkable errors due to spurious over- and under-mixing. In a heterogeneous velocity field (keeping the same constant and isotropic dispersion), the PT simulations show an increased reaction total from 0.221MA0 to 0.372MA0 due to fluid deformation, while the 1st-order Eulerian simulations using ˜ 106 cells (with a classical grid Peclet number ¿x/aL of 10) have total product of 0.53MA0, or approximately twice as much additional reaction due to advection error. The 3rd-order TVD algorithm fares better, with total product of 0.394MA0, or about 1.14 times the increased reaction total. A very strict requirement on grid Peclet numbers for Eulerian simulations will be required for realistic reactions because of their nonlinear nature. We analytically estimate the magnitude of the effect for the end-member cases of very fast and very slow reactions and show that in either case, the mass produced is proportional to View the MathML source where Pe is the Peclet number. Therefore, extra mass is produced according to View the MathML source where the dispersion includes any numerical dispersion error. We test two PT methods, one that kills particles upon reaction and another that decrements a particle’s mass. For the bimolecular reaction studied here, the computational demands of the particle-killing methods are much smaller than, and the particle-number-preserving algorithm are on par with, the fastest Eulerian methods.Peer ReviewedPostprint (author's final draft

Genetic Drivers of Kidney Defects in the DiGeorge Syndrome

Background The DiGeorge syndrome, the most common of the microdeletion syndromes, affects multiple organs, including the heart, the nervous system, and the kidney. It is caused by deletions on chromosome 22q11.2; the genetic driver of the kidney defects is unknown. Methods We conducted a genomewide search for structural variants in two cohorts: 2080 patients with congenital kidney and urinary tract anomalies and 22,094 controls. We performed exome and targeted resequencing in samples obtained from 586 additional patients with congenital kidney anomalies. We also carried out functional studies using zebrafish and mice. Results We identified heterozygous deletions of 22q11.2 in 1.1% of the patients with congenital kidney anomalies and in 0.01% of population controls (odds ratio, 81.5; P=4.5×10(-14)). We localized the main drivers of renal disease in the DiGeorge syndrome to a 370-kb region containing nine genes. In zebrafish embryos, an induced loss of function in snap29, aifm3, and crkl resulted in renal defects; the loss of crkl alone was sufficient to induce defects. Five of 586 patients with congenital urinary anomalies had newly identified, heterozygous protein-altering variants, including a premature termination codon, in CRKL. The inactivation of Crkl in the mouse model induced developmental defects similar to those observed in patients with congenital urinary anomalies. Conclusions We identified a recurrent 370-kb deletion at the 22q11.2 locus as a driver of kidney defects in the DiGeorge syndrome and in sporadic congenital kidney and urinary tract anomalies. Of the nine genes at this locus, SNAP29, AIFM3, and CRKL appear to be critical to the phenotype, with haploinsufficiency of CRKL emerging as the main genetic driver. (Funded by the National Institutes of Health and others.)

What Happened to Gray Whales during the Pleistocene? The Ecological Impact of Sea-Level Change on Benthic Feeding Areas in the North Pacific Ocean

Gray whales (Eschrichtius robustus) undertake long migrations, from Baja California to Alaska, to feed on seasonally productive benthos of the Bering and Chukchi seas. The invertebrates that form their primary prey are restricted to shallow water environments, but global sea-level changes during the Pleistocene eliminated or reduced this critical habitat multiple times. Because the fossil record of gray whales is coincident with the onset of Northern Hemisphere glaciation, gray whales survived these massive changes to their feeding habitat, but it is unclear how.We reconstructed gray whale carrying capacity fluctuations during the past 120,000 years by quantifying gray whale feeding habitat availability using bathymetric data for the North Pacific Ocean, constrained by their maximum diving depth. We calculated carrying capacity based on modern estimates of metabolic demand, prey availability, and feeding duration; we also constrained our estimates to reflect current population size and account for glaciated and non-glaciated areas in the North Pacific. Our results show that key feeding areas eliminated by sea-level lowstands were not replaced by commensurate areas. Our reconstructions show that such reductions affected carrying capacity, and harmonic means of these fluctuations do not differ dramatically from genetic estimates of carrying capacity.Assuming current carrying capacity estimates, Pleistocene glacial maxima may have created multiple, weak genetic bottlenecks, although the current temporal resolution of genetic datasets does not test for such signals. Our results do not, however, falsify molecular estimates of pre-whaling population size because those abundances would have been sufficient to survive the loss of major benthic feeding areas (i.e., the majority of the Bering Shelf) during glacial maxima. We propose that gray whales survived the disappearance of their primary feeding ground by employing generalist filter-feeding modes, similar to the resident gray whales found between northern Washington State and Vancouver Island

A Network Biology Approach Identifies Molecular Cross-Talk between Normal Prostate Epithelial and Prostate Carcinoma Cells

© 2016 The Authors. Published by Public Library of Science. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pcbi.1004884The advent of functional genomics has enabled the genome-wide characterization of the molecular state of cells and tissues, virtually at every level of biological organization. The difficulty in organizing and mining this unprecedented amount of information has stimulated the development of computational methods designed to infer the underlying structure of regulatory networks from observational data. These important developments had a profound impact in biological sciences since they triggered the development of a novel data-driven investigative approach. In cancer research, this strategy has been particularly successful. It has contributed to the identification of novel biomarkers, to a better characterization of disease heterogeneity and to a more in depth understanding of cancer pathophysiology. However, so far these approaches have not explicitly addressed the challenge of identifying networks representing the interaction of different cell types in a complex tissue. Since these interactions represent an essential part of the biology of both diseased and healthy tissues, it is of paramount importance that this challenge is addressed. Here we report the definition of a network reverse engineering strategy designed to infer directional signals linking adjacent cell types within a complex tissue. The application of this inference strategy to prostate cancer genome-wide expression profiling data validated the approach and revealed that normal epithelial cells exert an anti-tumour activity on prostate carcinoma cells. Moreover, by using a Bayesian hierarchical model integrating genetics and gene expression data and combining this with survival analysis, we show that the expression of putative cell communication genes related to focal adhesion and secretion is affected by epistatic gene copy number variation and it is predictive of patient survival. Ultimately, this study represents a generalizable approach to the challenge of deciphering cell communication networks in a wide spectrum of biological systems.Cancer research UK, BBSRC, NI